Current Issues and Options: Coverage and Reimbursement for Complex Molecular Diagnostics


In June 2008, HHS commissioned this white paper to overview the current status of payor systems for coverage and reimbursement of complex molecular
tests, and brought together an expert panel to discuss present difficulties and possibilities for change. The workshop focused on benefit classification, billing processes, coding systems, payment systems, and coverage decision processes. The goal of the workshop was not to choose single solutions, but to articulate the most pressing issues and discuss options for system change. Participants felt that the legacy coding system was the most pressing problem in the overall reimbursement system, but other parts of the payor process offer opportunities for improvement as well. [35 PDF pages]

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